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Ventilator-associated pneumonia during weaning from mechanical ventilation: role of fluid management.
Chest. 2014 Mar 20;
Authors: Dessap AM, Katsahian S, Roche-Campo F, Varet H, Kouatchet A, Tomicic V, Beduneau G, Sonneville R, Jaber S, Darmon M, Castanares-Zapatero D, Brochard L, Brun-Buisson C
Abstract
ABSTRACT BACKGROUND: Pulmonary edema may alter alveolar bacterial clearance and infectivity. Manipulation of fluid balance aimed at reducing fluid overload may therefore influence ventilator-associated pneumonia (VAP) occurrence in intubated patients. The objective of the present study was to assess the impact of a depletive fluid management strategy on ventilator-associated complication (VAC) and VAP occurrence during weaning from mechanical ventilation.
METHODS: We used data from the B-type natriuretic peptide for the fluid Management of Weaning (BMW) randomized controlled trial performed in nine intensive care units across Europe and America. We compared the cumulative incidence of VAC and VAP between the biomarker-driven depletive fluid management group and the usual care group during the 14 days following randomization, using specific competing risk methods (Fine and Gray model).
RESULTS: Among the 304 patients analyzed, 41 experienced VAP, including 27 (17.8%) in the usual care group vs. 14 (9.2%) in the interventional group (p=0.03). From the Fine and Gray model, the probabilities of VAC and VAP occurrence were both significantly reduced with the interventional strategy while adjusting for weaning outcome as a competing event [sub-hazard ratios of 0.44 (0.22-0.87), p=0.02 and 0.50 (0.25-0.96), p=0.03, respectively].
CONCLUSIONS: Using proper competing risk analyses, we found that a depletive fluid management strategy when initiating the weaning process has the potential for lowering VAP risk in mechanically ventilated patients.
CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov (NCT00473148).
PMID: 24652410 [PubMed - as supplied by publisher]